Carson Castellani – Cardiovascular Disease Physician

Key facts

NPI: 1770144461
Entity type: Individual (NPI type 1)
Primary specialty: Cardiovascular Disease Physician 207RC0000X
License: 81109-20 (WI)
Practice address: 2900 W Oklahoma Ave
Milwaukee, WI 53215-4330
Phone: (414) 649-6000
Fax: (414) 649-6583
NPI assigned: Jun 24, 2019
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

University Physician Group Social Worker · Livonia, MI · NPI 1154360402

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in WI
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20200806002003	WI	Order and Referring Only - General Surgery Practitioner - General Surgery	4789009879

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
81109-20	WI	MD	Cardiovascular Disease Physician

Practice roles

Organization	Specialty	Status	New patients
University Physician Group		Past	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Cardiovascular Disease Physician	207RC0000X	81109-20	WI	Yes

Addresses

Primary practice location

2900 W Oklahoma Ave
Milwaukee, WI 53215-4330

Mailing address

540 E Canfield St
Detroit, MI 48201-1928

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 30, 2023.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682812800000",
    "number": "1770144461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 E CANFIELD ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 W OKLAHOMA AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532154330",
            "telephone_number": "414-649-6000",
            "fax_number": "414-649-6583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CASTELLANI",
        "first_name": "CARSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-24",
        "last_updated": "2023-04-30",
        "certification_date": "2023-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "WI",
            "license": "81109-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

All providers in Milwaukee, WI · Cardiovascular Disease Physician in Wisconsin

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2023. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.